Report: Medicare agency not doing enough to stop duplicate audits

The Centers for Medicare and Medicaid Services (CMS) must do a better job of ensuring its auditors aren’t conducting duplicate reviews of payments to healthcare providers, according to the Government Accountability Office.

While the CMS has improved its oversight of contractors, the accountability office said the agency still can’t reliably ensure that payments aren’t reviewed twice.

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“CMS requires its contractors to include certain content in postpayment review correspondence with providers, but some requirements vary across contractor types and are not always clear, and contractors vary in their compliance with their requirements,” said the report.

Lawmakers in both parties have criticized the CMS for not doing a better job of making sure providers are not being penalized for minor administrative mistakes or reviewed for the same issue by multiple auditors.

In particular, they have been highly critical of the Recovery Audit Contractor program, which lawmakers have said is threatening to put some healthcare providers out of business because of lengthy and frivolous investigations.

“CMS has a duty to safeguard scarce taxpayer dollars and streamline postpayment claims reviews, but as GAO says, it has failed to do so,” said Hatch. “CMS’s current efforts to coordinate with contractors in reducing duplicative programs are simply inadequate.”

The GAO recommends the CMS improve oversight and provide guidance on auditor data, duplicate reviews and contractor communications. The agency also said the CMS agrees with its recommendations and is working to implement them.